In order to achieve optimum Health and Wellness,
consumers need to start on an HerbalCeuticals product that is right for them
today. Individuals need to incorporate a healthy lifestyle into there
daily health regimes as well.
The
relationship between diet and heart disease
has been the focus of much debate and scientific research for over a century.
Many foods and various diet patterns have fallen in and out of favor almost in
keeping with the change of seasons. With each new headline, manufacturers have
responded with new products, from fat-free egg substitutes, omega-3 enriched
eggs, cholesterol-free margarine to calcium-fortified spreads. If you find
yourself a bit confused about what to eat as you read the headlines, you are not
alone.
There are modifiable risk factors for
developing coronary heart disease, which can lead to a
heart attack or stroke. Some of
these risk factors, such as high blood cholesterol,
high blood pressure (hypertension),
obesity (defined as a BMI greater than 30)
and diabetes, can significantly be
influenced by the foods we eat and our dietary pattern. This is especially
important since; according to the American Heart Association, (Heart Disease
and Stroke Statistics, 2003) cardiovascular disease is the leading cause of
death in the United States, claiming almost 40 percent of all deaths in 2000.
Researchers now know more about the controllable risk factors for
coronary artery disease (CAD) than many
other diseases. To reduce the risk of cardiovascular disease, the National
Cholesterol Education Program (NCEP) recommends therapeutic lifestyle changes
(TLC). These guidelines, as well as guidelines developed by the American Heart
Association (October 2000), encourage the following:
-
A heart-healthy eating pattern that includes a variety of fruits,
vegetables, grains, low-fat or non-fat dairy products, fish, legumes
(beans), poultry and lean meats.
-
Achieving and maintaining a healthy body weight by balancing energy
intake (calories eaten) with energy
needs.
-
Participating in regular physical activity
for 30 to 60 minutes on most if not all days.
-
Smoking
cessation.
-
Achieving and maintaining desirable blood lipid
profile by limiting foods high in
saturated fats, trans fats
and cholesterol; and substituting healthier fats such as
monounsaturated and
polyunsaturated fats from vegetables, fish, legumes and nuts.
-
Achieving and maintaining normal blood pressure
levels by limiting salt and
alchohol intake, maintaining a healthy
body weight and eating a heart-healthy diet.
A heart-healthy eating plan includes a wide variety of foods high in complex
carbohydrates, fiber and vitamins and minerals.
It is also low in fat, cholesterol and salt. This article describes a
heart-healthy, balanced diet that can be used to help reduce the risk of
cardiovascular disease and related conditions such as obesity (body
mass index [BMI] greater than or equal to 30), high blood pressure
(hypertension) and atherosclerosis
(hardening and narrowing of the arteries).
What are
the basic guidelines to a heart-healthy diet?
The Nutrition Committee of the American Heart Association, reviewing decades of
research, put together Dietary Guidelines for Healthy American Adults
(October 2000) to outline the best strategies for eating a heart-healthy diet.
Formerly named Step 1 and Step 2 diets, the revised guidelines
focus on the need for all Americans to achieve and maintain a healthy body
weight through healthy food choices and dietary lifestyle practices.
These “major guidelines” are designed for all Americans over 2 years of age and
replace the Step 1 dietary recommendations. For higher-risk individuals,
such as those with diabetes,
cardiovascular disease or
lipid disorders for example, they recommend
following the National Cholesterol Education Program (NCEP) Therapeutic
Lifestyle Changes (TLC) diet which is a more individualized approach
involving medical nutrition therapy. The TLC
diet replaces the former Step 2 recommendations. To achieve and maintain
a heart-healthy eating pattern, the following guidelines are recommended:
-
Eat a variety of fruits and vegetables. Choose five or more servings of
whole fruits and vegetables – especially dark green, orange or yellow – each
day.
-
Eat a variety of grain products, especially whole grains, choosing six
or more servings per day.
-
Include low-fat or fat-free dairy products, fish (at least two servings
per week), legumes (beans), poultry (skin removed) and lean meats.
-
Limit cholesterol-raising fats such
as saturated fats and
trans fats. Limit full-fat dairy
products, high-fat meats, fried foods, products made with partially
hydrogenated vegetable oils, tropical oils (e.g., palm kernel oil, palm oil
or coconut oil) and egg yolks. Instead, choose fats
and oils with two grams or less saturated fat per tablespoon,
low-fat or non-fat dairy products, and lean meats. In addition, limit
dietary cholesterol intake to less than 300 mg per day.
-
Balance the total number of calories
(energy) you eat with the total energy used each day to maintain a healthy
body weight.
-
Maintain a level of physical activity
that keeps you fit and matches your energy (calorie) intake to maintain a
healthy body weight. Participate in at least 30 minutes of physical activity
on most days. For weight loss, maintain
an activity level that exceeds the amount of calories that you eat every
day.
-
Limit intake of foods that are high in calorie content and low in
nutrition including foods with a high sugar content such as soft drinks or
candy.
-
Consume less than 2,400 milligrams of sodium per day. This is about a
teaspoon of salt per day. People with
high blood pressure (hypertension) should
strive for even lower intake. Avoid salty foods and cut back on adding salt
to your foods during or after cooking. Check food
labels for salt content of packaged foods.
-
Limit alcohol intake to no more than
one alcoholic drink per day for women and no more than two drinks for men.
(One drink= 12 ounces of beer, 4 ounces wine, 1.5 ounce of 80-proof spirits
or one ounce of 100-proof spirits.)
These guidelines encourage eating a wide variety of foods high in complex
carbohydrates from whole grains, fiber and vitamins and
minerals. This diet is also low in fat, cholesterol and salt. Eating
excessive amounts of foods (especially foods high in saturated fat, sugar and
salt) should be avoided. Every meal or dinner party may not meet all these
guidelines. Instead of concentrating on each meal, these guidelines should be
applied to achieve an overall heart-healthy eating pattern.
It is important to maintain a healthy body weight by balancing calorie intake
with calories used and to participate in regular exercise. Following a
heart-healthy diet, achieving a healthy body weight and becoming physically
active can reduce heart disease risk as well
as other chronic health problems such as type 2
diabetes, osteoporosis (bone
loss) and some forms of cancer.
How can an
unhealthy diet harm the heart?
Food provides the human body with the building blocks (nutrients) and fuel
(energy) that are required for healthy function. Food is more than essential,
however. For many, it is truly enjoyed on an emotional level – to be savored as
an experience and viewed as a work of art.
Unfortunately, food has been linked to both emotional and physical problems.
From an emotional perspective, food can be used to fill a feeling of emptiness
or to gain a sense of control, sometimes leading to eating disorders such as
anorexia nervosa. From a physical perspective,
the quality of one’s diet can be a powerful contributor to the development of
many diseases, of which heart-related problems are among the most serious. Diets
that are high in cholesterol and certain
fats and oils greatly increase the risk of the
following:
-
Hardened and narrowed arteries (atherosclerosis)
as early as childhood
-
High blood pressure (hypertension)
-
Obesity (defined as a BMI greater
than 30), which can put tremendous strain and additional workload on the
heart. In fact, obesity ranks second only to
smoking as a leading contributor to death in the United States.
What is a balanced diet?
A balanced diet provides the body with the energy and nutrients it needs
to stay in good working order. It also prevents an excess of non-nutritious or
potentially harmful substances from causing damage to organs, tissues and
blood vessels. In general, a balanced
heart-healthy diet should contain the following:
-
Total Energy: Balance of energy (calorie)
intake and of calories used each day to maintain a healthy body weight and
to prevent excessive weight gain. To estimate the total energy needs to
maintain one's current body weight, multiply the number of pounds you weigh
by 15 calories if you are moderately active, (multiply by 13 calories if you
are less active).
-
Protein: Approximately 15 percent of total energy
-
Carbohydrate: 50 to 60 percent of total energy
-
Total fat: 25 to 35 percent
of total energy
-
Saturated fat: Less than seven
percent of total energy
-
Polyunsaturated fat: Up to 10
percent of total energy
-
Monounsaturated fat: Up to 20
percent of total energy
-
Fiber: 20 to 30 grams or more per
day
-
Vitamins and minerals
-
Water
Furthermore, the amount of these substances needed by the body is taken into
account. For instance, carbohydrates are macronutrients,
so they are required in greater amounts than micronutrients such as vitamins or
minerals.
The U.S. Department of Agriculture (USDA) established specific guidelines for a
balanced diet. The Food Guide Pyramid
illustrates the recommended number of servings that individuals should eat in
each category and provides a relative indication as to the fat and added sugars
found in each food. The food categories, suggested daily servings*, examples of
serving sizes as well as heart-healthy options are as follows:
|
Food Groups
(suggested daily servings*) |
Serving Sizes |
Heart-Healthy Choices |
|
Bread, cereal, rice and pasta
(6 to 11 servings/day) |
1
slice of bread
1 cup of cereal
½ cup of cooked cereal, rice or pasta |
Choose low-fat, whole grain breads, cereals and grains (rolled oats,
whole wheat bread, brown rice, barley, etc.). Avoid added salt, sugar or
fats (e.g., saltines, croissants, biscuits, muffins, donuts). |
|
Vegetables
(3 to 5 servings) |
1 cup
of raw or leafy vegetables
½ cup of cooked vegetables
¾ cup of vegetable juice |
Choose a variety of vegetables, including dark green or orange
vegetables (e.g., broccoli, spinach, carrots, squash and sweet
potatoes.) Avoid adding fats while cooking or as dressings. |
|
Fruits
(2 to 4 servings) |
1
piece of medium-size fruit
½ cup of chopped, cooked or canned fruit
¾ cup of 100 percent fruit juice |
Choose a variety of fruits and unsweetened fruit juices. |
|
Milk,
yogurt and cheese
(2 to 3 servings) |
1 cup
of milk or yogurt
1-½ ounces of natural cheese
2 ounces of processed cheese |
Choose lower fat dairy products such as low-fat or fat-free milk and
yogurt, low-fat cheese (less than 20 percent milkfat) or low-fat cottage
cheese. |
|
Meat,
poultry, fish, beans, eggs and nuts
2 to 3 servings |
2 to
3 ounces of cooked lean meat
½ cup of cooked dry beans
½ cup of tofu
A 2-½ ounce soy burger
1 egg
1/3 cup nuts |
Choose lean meats with all visible fat trimmed. Eat fish at least twice
a week. Instead of meat, try to substitute beans such as lentils, black
beans, or chick peas a few times per week. Avoid high fat, high
cholesterol meats; such as bacon, sausage, organ meats or pate. Limit
egg yolks to two or less per week. |
|
Fats,
oils and sweets
Only use sparingly
(amount of fats/oils adjusted to calorie level) |
1 tsp
vegetable oil
1 Tbsp salad dressing
2 tsp mayonnaise |
Choose oils high in unsaturated fats such as canola, corn, safflower or
olive oils. Liquid or soft margarines without
hydrogenated fats and less than 2 grams of saturated fat per
tablespoon. Limit butter, hard margarines, lard, shortening or coconut
milk. Avoid "empty calorie" sweets such as soft drinks or candy. |
* The number
of servings will vary with each individual, based on factors such as age, sex
and level of physical activity. According to
the USDA, this is because the number of servings is based on the total number of
total calories required, ranging from about 1,600 calories for children and
women to about 2,800 calories for teenage boys and active adult males
Which dietary factors affect heart health?
The goal of a heart-healthy diet is to eat a variety of foods that help
to obtain and maintain a healthy body weight, healthy blood
lipid profile and to keep
blood pressure under control. One strategy for
improving your blood presuure and blood lipid profile is to eat a well-balanced
heart-healthy diet. For people with heart disease
or who are at high risk of heart disease, the Third Report (May 2001) of the
National Cholesterol Education Program (NCEP) recommends targeting not only
total blood cholesterol levels but also
low-density lipoprotein (LDL, “bad”
cholesterol) levels. Based on decades of scientific research, the Therapeutic
Lifestyle Change (TLC) diet developed by the NCEP to lower heart disease
risk makes the following recommendations:
-
Total fat should make up 25 to 35
percent of daily energy intake. Since most foods high in fat are also high
in saturated fat and
calories, limiting total fat intake may
help to maintain healthy weight and blood cholesterol levels.
-
Reduce saturated fat in the diet to less than 7 percent of total energy
(calorie) intake. Studies have shown that diets high in saturated fat
increase LDL cholesterol and total cholesterol levels. The good news is that
the opposite is also true and reducing the amount of saturated fat you eat
can help lower your blood levels of LDL cholesterol and total cholesterol.
-
Trans fats should be limited as much
as possible in the diet. Trans fats raise LDL cholesterol, increasing the
risk of heart disease. Avoid hydrogenated or partially hydrogenated fats
(listed under the ingredients list on food
labels), hard margarines or packaged foods prepared with these
ingredients.
-
Monounsaturated fats derived from
plant oils and nuts can replace saturated fats in your diet up to 20 percent
of total energy. Monounsaturated fats lower LDL or "bad" cholesterol without
lowering high-density lipoprotein (HDL, "good" cholesterol) levels when
substituted for saturated fats in the diet. People consuming a traditional
Mediterranean diet high in fruits, vegetables, whole grains, fish and
unsaturated fats (especially monounsaturated fat from olive oil) generally
have lower rates of cardiovascular disease.
-
Polyunsaturated fats can also
replace saturated fats in the diet up to 10 percent of total energy. These
fats lower LDL or "bad" cholesterol and can cause small reductions in HDL or
"good" cholesterol when substituted for the saturated fats in the diet. It
is important that the dietary sources of polyunsaturated fats come from
liquid vegetable oils and semi-liquid margarines that are low in trans fats.
-
Consume less than 200 milligrams per day of dietary cholesterol. Dietary
cholesterol is found only in foods that are made from or contain animal
products. Reducing dietary cholesterol intake can help to lower LDL
cholesterol levels.
-
Weight loss is encouraged in
overweight patients, with the goal of achieving and maintaining a healthy
body weight (body mass index between
18.5 and 25). Weight loss of even a few pounds in overweight patients can
reduce LDL cholesterol levels.
-
Carbohydrates should make up 50 to 60 percent of total daily energy
intake. Very high intakes of carbohydrates (greater than 60 percent) may
lower HDL or "good" cholesterol levels and increase
triglyceride levels. Sweets or even
“low-fat” foods, if high in sugar content, can cause weight gain, not to
mention tooth decay. Sweets (foods high in simple sugars) such as cakes,
candies, sweetened fruit beverages and regular sodas tend to be high in
calories and low in essential nutrients (i.e., “empty” calories). Instead
choose complex carbohydrates that are also a good source of dietary fiber.
-
Soluble fiber (five to 10
grams per day) can help to lower LDL and total cholesterol levels. Foods
high in soluble fiber content include fruits and vegetables, legumes (beans)
and cooked cereals such as oats and grains.
-
Plant stanols/sterols intake of 2 to 3 grams a day can help to
lower “bad” or LDL cholesterol levels. Sources are foods derived from plants
such as fruits and vegetables. Margarine spreads that contain stanol/sterol
esters are also available. These speads may also lower beta-carotene levels
and are designed mainly for people diagnosed with high cholesterol levels.
The presence of plant stanols/sterols is listed on food labels.
-
Drinking alcohol to excess has many
harmful effects, including raising the risk of high
blood pressure (hypertension) and adding “empty” calories to your
diet. However, some studies have shown that moderate alcohol consumption
(i.e., no more than one drink per day for women and no more than two drinks
a day for men) may actually reduce the risk of heart disease. The choice of
alcohol as a preventive tool, however, should be balanced with its potential
risks. Therefore, everyone is encouraged to talk to their physician. People
who are encouraged to avoid alcohol include minors, individuals with a
family medical history of alcoholism,
pregnant women and persons on certain
medications.
-
Limit salt intake to 2400 milligrams
a day. This is about a teaspoon of salt per day. Salt contributes to high
blood pressure (hypertension). The Dietary
Approaches to Stop Hypertention (DASH) trial provided evidence
that a diet high in fruits, vegetables, low-fat dairy products, whole
grains, poultry, fish and nuts and low in fat, red meat, sweets can
favorably influence blood pressure. When this diet pattern is combined with
reduction in salt intake the benefits are additive and blood pressure is
lowered even more
Why are nutrition labels important?
For many, the challenge of planning a healthy diet may be in
knowing what foods to prepare to stay within a given range of
calories, fats
and so forth. It may require developing daily or weekly menus in advance, and a
food log may also be helpful. Fortunately, keeping track of the amount of
nutrients in certain foods is easy. Food values can be found on everyday food
products — right on the label. By learning how to read a
nutrition label, it will be easier to prepare a
heart-healthy meal.
The nutrition label, titled Nutrition Facts, is required by law to be
included on the labels of most foods that are not considered “fresh,” though
some fresh products may include the information by choice. Certain foods are
exempt from mandatory labeling. These foods include restaurant-prepared foods,
ready-to eat bakery or deli foods and products with no nutritional value (e.g.,
spices or coffee beans). The nutrition label gives information about the
following:
-
Total calories
-
Calories from fat
-
Total fat
-
Saturated fat
-
Cholesterol
-
Sodium
-
Total carbohydrates
-
Dietary fiber
-
Sugars
-
Protein
-
Vitamin A
-
Vitamin C
-
Calcium
-
Iron
The amount of each of these is listed by actual content (usually measured in
milligrams or grams) and as a percentage of the U.S. Recommended Daily Allowance
(USRDA). The USRDA is what the government suggests that people consume of each
nutrient per day, based on a 2,000-calorie diet. So if a cup of yogurt only
satisfies 30 percent of the USRDA for calcium, then in addition to eating that
cup of yogurt, someone would also need to get another 70 percent of their daily
need for calcium from other sources through the day. The label also provides
portioning information (whether there is one serving in the whole
package/container, or multiple servings per package/container.)
The Food and Drug Administration (FDA)
endorses the use of food label analysis for individuals susceptible to,
suffering from or recently treated for heart disease.
This is because the amount of saturated fat, cholesterol and sodium is readily
available to the consumer. In addition, fiber content is listed on the label.
Low-fat foods that are also a good source of fiber tend to be heart healthy. By
reading the food label and learning to prepare food in a heart-healthy fashion,
many people find it simple to maintain a nutritious diet – one full of variety,
creative to prepare and truly enjoyable to eat.
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